[naturenews] from [nature.com]
[naturenews]
Published online 10 February 2010 | Nature | doi:10.1038/news.2010.60
News
Changes proposed to key psychiatry manual
Controversial revision alters diagnostic definitions.
Heidi Ledford
The American Psychiatric Association is unveiling a host of suggested changes to its influential Diagnostic and Statistical Manual of Mental Disorders (DSM). Proposed revisions include uniting several autism-related diagnoses, including Asperger's syndrome and Rett's syndrome, under the umbrella of autism spectrum disorder; introducing a diagnosis of gambling addiction; and eliminating the distinction between alcohol dependence and alcohol abuse.
The proposals, to be posted to the association's website on 10 February, will be open for public comment until 20 April. In July, the association will begin testing the changes in academic centres and hospitals by asking psychiatrists to feed back on how their work would be different using the new diagnoses. The revised manual, known as DSM-V because it is the fifth edition, is to be released in May 2013.
The DSM is used to diagnose patients and guide research, primarily in the United States. Subtle changes to past editions have been credited with wide-reaching effects such as increasing the number of children diagnosed with autism or allowing accused criminals to go free on the basis of a psychiatric diagnosis. As a result, revising the manual can be a delicate issue.
The current revision has been particularly troubled (see Psychiatry manual revisions spark row). Rumours suggested that the new edition might include such controversial diagnoses as addiction to food, shopping, or the internet.
The process, too, came under fire. Last March, Jane Costello of Duke University in Durham, North Carolina, resigned from the work group on childhood and adolescence, saying that she felt pushed to make changes that were not adequately backed by research.
Months later, the group lost another member, Fred Volkmar of Yale University in New Haven, Connecticut. "I found myself increasingly uncomfortable with the process," he says. In the past, he says, proposed changes were often published early in peer-reviewed journals.
Changes under fire
One new proposal that concerns Volkmar is the decision to lump autism-related disorders into a single category called 'autism spectrum disorder'. The changes reflect recent autism research, he says, but he is concerned that the change was proposed without adequately considering its social ramifications. A diagnosis of 'autism' is often required to obtain social services such as access to special education programmes. "I worry that there'll be some potential for diluting the pool of services for children really in need," says Volkmar.
Other proposed changes run the gamut from eliminating the term 'mental retardation' — to be replaced with a new 'intellectual disability' category — to introducing diagnoses such as 'psychosis risk syndrome' and 'mild neurocognitive disorder', which are designed to catch patients in the early stages of a disorder. Early diagnosis could help target patients for early intervention, says William Carpenter, chair of the psychotic disorders work group and director of the Maryland Psychiatric Research Center in Baltimore.
But he acknowledges that such categories can lead to diagnosing many people who will not go on to develop a full-blown condition such as Alzheimer's disease. To avoid this, the categories include only those patients who seek help specifically for the symptoms associated with these conditions.
Another proposed change is to eliminate the distinction between alcohol abuse and alcohol dependence. "I think clinicians who deal with alcohol problems are not going to be too happy that they can't make that distinction," says psychiatrist Robert Spitzer of Columbia University in New York.
But Nora Volkow, director of the National Institute on Drug Abuse in Bethesda, Maryland, says the change in the alcohol definition is a step in the right direction, because abuse was previously seen as a necessary step on the path to dependence. "Individuals can become dependent without passing through the abuse phase," she says. "The data are clear on that."
Not all proposed changes made it in. Volkow, for instance, had lobbied to include addiction to food, which did not make the final cut because the working group felt there is still insufficient scientific evidence to back the diagnosis. It remains to be seen whether the other proposed revisions will survive the public comment period.
[naturenews]
Published online 9 February 2010 | Nature 463, 719 (2010) | doi:10.1038/463719a
News
Testing time for stem cells
Industry turns to cell lines for drug screens.
Monya Baker
{{A deal between Roche and two academic institutions will focus on stem-cell-based drug screening.}
Roche}
The drug industry is keener on stem-cell technologies than ever before ┄ and not just as a source of new treatments. A wave of new partnerships aims to use stem cells as a way to screen other potential drug candidates.
In the latest such example, Roche last week announced a deal worth some US$20 million with Harvard University in Cambridge, Massachusetts, and Massachusetts General Hospital in Boston. Roche, based in Basel, Switzerland, will use cell lines and protocols developed by academic researchers to screen for drugs to treat cardiovascular disease and other conditions.
Because relevant human cell types are often unavailable, current screens tend to use cells from rodents or human tissues other than the ones researchers want to target. The hope is that stem cells could provide exactly the type of cells relevant for an assay.
The deal is the latest in a string of similar partnerships. Within the past 15 months, Pfizer of New York and GE Healthcare of Chalfont St Giles, UK, signed deals geared towards using stem cells in drug discovery with the California companies Novocell of San Diego and Geron of Menlo Park, respectively. In 2008, GlaxoSmithKline teamed up with the Harvard Stem Cell Institute for research in neuroscience, heart disease, cancer, diabetes, musculoskeletal diseases and obesity. And in 2006, AstraZeneca of London began collaborating with Cellartis of Gothenburg, Sweden, to use stem cells to make human liver and heart cells for safety tests.
Although using stem cells for drug screening and early research should be easier than developing them into replacement tissues, even the most ardent advocates admit that it won't be straightforward. "At the moment it's all really early days," says Stephen Minger, who left King's College London last year to head GE Healthcare's efforts to develop drug-screening tests with cells derived from human embryonic stem cells.
"What needs to be demonstrated is the actual application of the technology," adds John Walker, the chief executive of iPierian, a stem-cell company in San Francisco, California. The firm has created motor neurons using induced pluripotent stem (iPS) cells derived from people with and without spinal muscular atrophy, a neurodegenerative disease. Company scientists are investigating whether drug candidates can disrupt telltale protein clumps seen in neurons derived from affected individuals. Eventually, this work could lead to what Walker calls an "in vitro clinical trial" in which iPS cells derived from a wide variety of individuals could be used to predict patients' response to a drug.
Most drug companies remain to be convinced that new screens can predict drugs' properties as well as or better than existing methods. They also don't know whether cells can be produced reliably in sufficient quantities for screening, and whether regulatory agencies will accept data derived from them.
Roche says that it is already running screens based on stem cells to test drugs for cardiotoxicity and effects on neurogenesis. Matthias Steger, the company's global business development director for stem-cell alliances, says that under the latest deal, Harvard and Massachusetts General Hospital will work on embryonic stem cells and iPS cells derived from individuals with various forms of cardiovascular disease. The institutions will receive milestone payments as screens are validated, and the collaboration will last 3–5 years.
Ruth McKernan, chief scientific officer of Pfizer's regenerative medicine unit, notes that although screens based on stem cells will be useful, they are not the main reason that Pfizer is interested in these cells. "This progress, though important, is incremental when compared to the real promise in using these cells as therapeutics," she says.
[naturenews]
Published online 10 February 2010 | Nature | doi:10.1038/news.2010.60
News
Changes proposed to key psychiatry manual
Controversial revision alters diagnostic definitions.
Heidi Ledford
The American Psychiatric Association is unveiling a host of suggested changes to its influential Diagnostic and Statistical Manual of Mental Disorders (DSM). Proposed revisions include uniting several autism-related diagnoses, including Asperger's syndrome and Rett's syndrome, under the umbrella of autism spectrum disorder; introducing a diagnosis of gambling addiction; and eliminating the distinction between alcohol dependence and alcohol abuse.
The proposals, to be posted to the association's website on 10 February, will be open for public comment until 20 April. In July, the association will begin testing the changes in academic centres and hospitals by asking psychiatrists to feed back on how their work would be different using the new diagnoses. The revised manual, known as DSM-V because it is the fifth edition, is to be released in May 2013.
The DSM is used to diagnose patients and guide research, primarily in the United States. Subtle changes to past editions have been credited with wide-reaching effects such as increasing the number of children diagnosed with autism or allowing accused criminals to go free on the basis of a psychiatric diagnosis. As a result, revising the manual can be a delicate issue.
The current revision has been particularly troubled (see Psychiatry manual revisions spark row). Rumours suggested that the new edition might include such controversial diagnoses as addiction to food, shopping, or the internet.
The process, too, came under fire. Last March, Jane Costello of Duke University in Durham, North Carolina, resigned from the work group on childhood and adolescence, saying that she felt pushed to make changes that were not adequately backed by research.
Months later, the group lost another member, Fred Volkmar of Yale University in New Haven, Connecticut. "I found myself increasingly uncomfortable with the process," he says. In the past, he says, proposed changes were often published early in peer-reviewed journals.
Changes under fire
One new proposal that concerns Volkmar is the decision to lump autism-related disorders into a single category called 'autism spectrum disorder'. The changes reflect recent autism research, he says, but he is concerned that the change was proposed without adequately considering its social ramifications. A diagnosis of 'autism' is often required to obtain social services such as access to special education programmes. "I worry that there'll be some potential for diluting the pool of services for children really in need," says Volkmar.
Other proposed changes run the gamut from eliminating the term 'mental retardation' — to be replaced with a new 'intellectual disability' category — to introducing diagnoses such as 'psychosis risk syndrome' and 'mild neurocognitive disorder', which are designed to catch patients in the early stages of a disorder. Early diagnosis could help target patients for early intervention, says William Carpenter, chair of the psychotic disorders work group and director of the Maryland Psychiatric Research Center in Baltimore.
But he acknowledges that such categories can lead to diagnosing many people who will not go on to develop a full-blown condition such as Alzheimer's disease. To avoid this, the categories include only those patients who seek help specifically for the symptoms associated with these conditions.
Another proposed change is to eliminate the distinction between alcohol abuse and alcohol dependence. "I think clinicians who deal with alcohol problems are not going to be too happy that they can't make that distinction," says psychiatrist Robert Spitzer of Columbia University in New York.
But Nora Volkow, director of the National Institute on Drug Abuse in Bethesda, Maryland, says the change in the alcohol definition is a step in the right direction, because abuse was previously seen as a necessary step on the path to dependence. "Individuals can become dependent without passing through the abuse phase," she says. "The data are clear on that."
Not all proposed changes made it in. Volkow, for instance, had lobbied to include addiction to food, which did not make the final cut because the working group felt there is still insufficient scientific evidence to back the diagnosis. It remains to be seen whether the other proposed revisions will survive the public comment period.
[naturenews]
Published online 9 February 2010 | Nature 463, 719 (2010) | doi:10.1038/463719a
News
Testing time for stem cells
Industry turns to cell lines for drug screens.
Monya Baker
{{A deal between Roche and two academic institutions will focus on stem-cell-based drug screening.}
Roche}
The drug industry is keener on stem-cell technologies than ever before ┄ and not just as a source of new treatments. A wave of new partnerships aims to use stem cells as a way to screen other potential drug candidates.
In the latest such example, Roche last week announced a deal worth some US$20 million with Harvard University in Cambridge, Massachusetts, and Massachusetts General Hospital in Boston. Roche, based in Basel, Switzerland, will use cell lines and protocols developed by academic researchers to screen for drugs to treat cardiovascular disease and other conditions.
Because relevant human cell types are often unavailable, current screens tend to use cells from rodents or human tissues other than the ones researchers want to target. The hope is that stem cells could provide exactly the type of cells relevant for an assay.
The deal is the latest in a string of similar partnerships. Within the past 15 months, Pfizer of New York and GE Healthcare of Chalfont St Giles, UK, signed deals geared towards using stem cells in drug discovery with the California companies Novocell of San Diego and Geron of Menlo Park, respectively. In 2008, GlaxoSmithKline teamed up with the Harvard Stem Cell Institute for research in neuroscience, heart disease, cancer, diabetes, musculoskeletal diseases and obesity. And in 2006, AstraZeneca of London began collaborating with Cellartis of Gothenburg, Sweden, to use stem cells to make human liver and heart cells for safety tests.
Although using stem cells for drug screening and early research should be easier than developing them into replacement tissues, even the most ardent advocates admit that it won't be straightforward. "At the moment it's all really early days," says Stephen Minger, who left King's College London last year to head GE Healthcare's efforts to develop drug-screening tests with cells derived from human embryonic stem cells.
"What needs to be demonstrated is the actual application of the technology," adds John Walker, the chief executive of iPierian, a stem-cell company in San Francisco, California. The firm has created motor neurons using induced pluripotent stem (iPS) cells derived from people with and without spinal muscular atrophy, a neurodegenerative disease. Company scientists are investigating whether drug candidates can disrupt telltale protein clumps seen in neurons derived from affected individuals. Eventually, this work could lead to what Walker calls an "in vitro clinical trial" in which iPS cells derived from a wide variety of individuals could be used to predict patients' response to a drug.
Most drug companies remain to be convinced that new screens can predict drugs' properties as well as or better than existing methods. They also don't know whether cells can be produced reliably in sufficient quantities for screening, and whether regulatory agencies will accept data derived from them.
Roche says that it is already running screens based on stem cells to test drugs for cardiotoxicity and effects on neurogenesis. Matthias Steger, the company's global business development director for stem-cell alliances, says that under the latest deal, Harvard and Massachusetts General Hospital will work on embryonic stem cells and iPS cells derived from individuals with various forms of cardiovascular disease. The institutions will receive milestone payments as screens are validated, and the collaboration will last 3–5 years.
Ruth McKernan, chief scientific officer of Pfizer's regenerative medicine unit, notes that although screens based on stem cells will be useful, they are not the main reason that Pfizer is interested in these cells. "This progress, though important, is incremental when compared to the real promise in using these cells as therapeutics," she says.
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